461 results on '"Lester J. Layfield"'
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202. Surgical control of clinically localized prostate carcinoma is equivalent in African-American and White males
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James W. Box, Judith E. Robertson, David F. Paulson, Robin T. Vollmer, Christophe E. Iselin, and Lester J. Layfield
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African american ,Cancer Research ,medicine.medical_specialty ,business.industry ,Prostatectomy ,medicine.medical_treatment ,Urology ,Prostate carcinoma ,medicine.disease ,Surgery ,White (mutation) ,medicine.anatomical_structure ,Oncology ,Prostate ,Carcinoma ,Medicine ,Radical surgery ,business ,Negroid - Abstract
Few studies have compared the outcome of radical prostatectomy between African-American males (AAM) and white males, and the results of the few studies that have are conflicting. Therefore, the authors examined the impact of radical surgery on localized prostate carcinoma in both patient populations, and assessed whether stratification by pathologic extent of local disease would yield an equivalent outcome. more...
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- 1998
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203. 'Dedifferentiated' chordoma: A case report of the cytomorphologic findings on fine-needle aspiration
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Lester J. Layfield, Leslie G. Dodd, Katharine Liu, and Babatunde A. Olatidoye
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Pathology ,medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,business.industry ,General Medicine ,Malignancy ,medicine.disease ,Pathology and Forensic Medicine ,Fine-needle aspiration ,Cytopathology ,Giant cell ,Medicine ,Osteosarcoma ,Chordoma ,Sarcoma ,business ,Fibrosarcoma - Abstract
Chordomas are relatively rare neoplasms occurring at both ends of a neuro axis. The majority follow an indolent course of multiple local recurrences, ultimately leading to the patient's death. Rare examples have been associated with sarcomatous components, usually resembling malignant fibrous histiocytoma, fibrosarcoma, or osteosarcoma. These tumors have followed a more aggressive course, with poor response to treatment and death following a relatively short time course. Cytologic material from a single case obtained by fine-needle aspiration revealed a high-grade malignancy composed of short atypical spindle cells containing modest amounts of granular cytoplasm. Physaliphorous cells were absent, and myxoid material was not a significant component of the smears. Rare polygonal cells with foamy cytoplasm were identified. Histologic study revealed a high-grade spindle-cell sarcoma in which were scattered small aggregates of vacuolated cells resembling physaliphorous cells. Anaplastic giant cells were present, and the overall appearance of the neoplasm resembled a malignant fibrous histiocytoma. Despite the radiographic appearance of a conventional chordoma in this case, the cytologic findings were indicative of a high-grade sarcoma consistent with a dedifferentiated chordoma. more...
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- 1998
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204. Logistic regression analysis of myxoid sarcomas: A cytologic study
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Lester J. Layfield, Katharine Liu, and Richard K. Dodge
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Myxoid liposarcoma ,Pathology ,medicine.medical_specialty ,Histology ,business.industry ,Myxoma ,General Medicine ,Anatomy ,Liposarcoma ,medicine.disease ,Myxoid chondrosarcoma ,Pathology and Forensic Medicine ,Giant cell ,Cytopathology ,medicine ,Pleomorphism (microbiology) ,Sarcoma ,business - Abstract
The objective of this study was to identify key diagnostic cytologic criteria for the most common myxoid sarcomas studied by fine-needle aspiration cytology. We reviewed 27 myxoid malignant fibrous histiocytomas, 8 chordomas, 16 chondrosarcomas, and 12 myxoid liposarcomas in which both cytologic specimens and final histopathologic diagnoses were available. All specimens were coded as to the presence or absence of the following variables: high cellularity, low cellularity, tissue fragments, epithelial fragments, pale/loose ground substance, dense ground substance, chondroid fragments, large amount of myxoid material, small amount of myxoid material, capillary vessel networks, pleomorphism, binucleate cells, multinucleate cells, physaliphorous cells, cells in lacunae, signet ring cells, lipoblasts, fibroblast-like cells, histiocyte-like cells, stellate cells, long filamentous cells, short spindle cells, osteoclastic giant cells, nuclei with pointed ends, nuclei with cigar-shaped ends, fish-hook nuclei, round/ovoid nuclei, naked nuclei, large nucleoli, small nucleoli, mitotic figures, abnormal mitotic figures, intracytoplasmic hemosiderin deposits, background cells, fat, cytoplasmic vacuoles, and pleomorphic giant cells. A logistic regression analysis was performed to identify the variables predictive of myxoid malignant fibrous histiocytoma, chordoma, myxoid chondrosarcoma, and myxoid liposarcoma. The statistical analysis selected pleomorphic giant cells and the presence of fibroblast-like cells as most predictive of malignant fibrous histiocytoma, physaliphorous cells as most closely associated with chordoma, chondroid fragments as most predictive of chondrosarcoma, and lipoblasts as most predictive of liposarcoma. While myxoid lesions have many overlapping cytologic features, key criteria including the presence of lipoblasts, physaliphorous cells, chondroid fragments, and pleomorphic giant cells are useful in subclassifying these neoplasms. more...
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- 1998
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205. Reporting fine-needle aspirates of breast: A survey of preferences among surgeons
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Hilliard F. Seigler, Eoghan E. Mooney, and Lester J. Layfield
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Gynecology ,medicine.medical_specialty ,Histology ,business.industry ,General surgery ,Mammary gland ,General Medicine ,medicine.disease ,Preference ,Pathology and Forensic Medicine ,Aspiration cytology ,Breast cancer ,medicine.anatomical_structure ,Cytopathology ,medicine ,Carcinoma ,Breast disease ,skin and connective tissue diseases ,business ,Breast nodules - Abstract
Background The optimal format for reporting results of breast fine-needle aspiration cytology is controversial, with some experts favoring a five-category system and others recommending a four-category format. Methods A survey of 200 surgeons was performed to determine their preference for a four- or five-category report format. They were also questioned concerning the number of patients per year in whom they diagnosed breast cancer, if they used fine-needle aspiration cytology (FNAC) regularly, and why they favored one category over the other. Results Eighty-five complete responses were received. Fifty-eight percent of these surgeons (49) routinely used FNAC for the diagnosis of breast nodules. There was no strong preference for either report format. Twenty-four of 49 routine users of FNAC favored a four-category format, and another four had no preference. Conclusion Surgeons who routinely used FNAC in the diagnosis of breast disease do not have a preference for the five-category probabilistic system. more...
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- 1998
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206. Not by blood alone: Diagnosis of hemangiomas by fine-needle aspiration
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Lester J. Layfield, Leslie G. Dodd, and Eoghan E. Mooney
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medicine.medical_specialty ,Pathology ,Histology ,medicine.diagnostic_test ,Vascular disease ,business.industry ,Soft tissue ,General Medicine ,medicine.disease ,eye diseases ,Malignant disease ,Pathology and Forensic Medicine ,body regions ,Angioma ,Hemangioma ,Fine-needle aspiration ,Cytopathology ,medicine ,Vascular Neoplasm ,sense organs ,Radiology ,business - Abstract
Hemangiomas are common vascular neoplasms which are being radiographically detected and biopsied with increasing frequency during the workup of patients with malignant disease. The increasing confidence of radiologists in biopsying these lesions is in contrast to the reluctance of pathologists to make a specific diagnosis of hemangioma. Eleven cases of hemangioma, from both hepatic and superficial sites, were reviewed and the fine-needle aspirate findings discussed and illustrated. Three-dimensional arcades composed of bland elongated spindle cells or compact dense coils of spindle cells associated with scattered spindle-shaped cells were identified in 10 of 11 cases. In conclusion, recognition of the cellular pattern of hemangiomas combined with the radiologic information can enable a positive diagnosis of hemangioma to be made. Diagn. Cytopathol. 1998;19:250–254. © 1998 Wiley-Liss, Inc. more...
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- 1998
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207. Fine-needle aspiration: Comparison of smear, cytospin, and cell block preparations in diagnostic and cost effectiveness
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Lester J. Layfield, Richard Dodge, Ben J. Glasgow, and Katharine Liu
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medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,business.industry ,Cost effectiveness ,General Medicine ,Pathology and Forensic Medicine ,Surgery ,Analyse cout efficacite ,Fine-needle aspiration ,Cytopathology ,medicine ,Radiology ,business ,Cell block - Abstract
We compared the results of smears to those of cytospin and cell block preparations from fine-needle aspirations to determine the cost effectiveness of each and to determine which should be routinely obtained. We reviewed 844 cases, 361 of which had both smears and cytospins, and 483 of which had both smears and cell blocks. Smears alone were diagnostic in 94% of cases (796/844 cases), cytospins alone diagnostic in 43% of cases (154/361 cases), and cell blocks alone diagnostic in 57% of cases (277/483 cases). Cytospins contributed additional information beyond that obtained from smears in 2% (7/361) and cell blocks in 12% (57/483) of cases. When smears were nondiagnostic, cytospins contributed additional information in 10% (2/21) of cases and cell blocks contributed additional information in 44% (12/27) of cases. The cost of providing a diagnosis from smear alone is $212, from cytospin alone is $352, and from cell block alone is $392. The cost for additional information established by cytospin is $7,736 and by cell block the cost is $1,906. Smears are superior to either cytospins or cell blocks in providing a diagnosis. It is not cost-effective to obtain either cytospins or cell blocks in addition to smears on all cases. However, it is cost-effective to obtain cell blocks when the immediate smear evaluation is nondiagnostic. more...
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- 1998
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208. Demonstration of myxoid change in fine-needle aspiration of synovial sarcoma: A case report
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Moffatt Ej, Katharine Liu, and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,Histology ,Soft Tissue Neoplasm ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Synovial sarcoma ,Pathology and Forensic Medicine ,Fine-needle aspiration ,Cytopathology ,Cytology ,Biopsy ,medicine ,Sarcoma ,Differential diagnosis ,business - Abstract
We report a case of synovial sarcoma with extensive myxoid change diagnosed by fine-needle aspiration. The patient is a 46-year-old woman who presented with a right paratibial mass. Aspiration cytology demonstrated a spindle cell neoplasm consistent with a synovial sarcoma but containing a prominent myxoid matrix. The clinical suspicion and cytologic diagnosis of a synovial sarcoma was confirmed by histologic and immunohistochemical findings. The cytologic differential diagnosis of spindle cell neoplasms with extensive myxoid change should be broadened to include synovial sarcoma. more...
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- 1998
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209. Association between Ratio of Matrix Metalloproteinase-1 to Tissue Inhibitor of Metalloproteinase-1 and Local Recurrence, Metastasis, and Survival in Human Chondrosarcoma*
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Lloyd A. Hey, Lester J. Layfield, Alison P. Toth, Keith R. Berend, Sean P. Scully, and John M. Harrelson
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Metalloproteinase ,Pathology ,medicine.medical_specialty ,business.industry ,General Medicine ,Matrix metalloproteinase ,Matrix (biology) ,Tissue inhibitor of metalloproteinase ,medicine.disease ,Mesenchymal chondrosarcoma ,Metastasis ,Medicine ,Interstitial collagenase ,Orthopedics and Sports Medicine ,Surgery ,Chondrosarcoma ,business - Abstract
Chondrosarcoma, a malignant cartilage-forming mesenchymal tumor, displays a wide range of clinical behavior that can be difficult to predict with histological analysis. Matrix metalloproteinases contribute to the processes of local invasion and metastasis by controlling the ability of a tumor to transverse tissue boundaries. The specificity of matrix metalloproteinase-1 (interstitial collagenase) for fibrillar collagen may be central to those processes. Matrix metalloproteinase-2 facilitates invasion by degradation of such basement-membrane structures as type-IV collagen. The balance between the activity of tissue inhibitors of metalloproteinase and the activity of matrix metalloproteinase determines the proteolytic activity and may, in part, determine the overall invasiveness and potential for metastasis. The measurement of the ratio of matrix metalloproteinase to tissue inhibitor of metalloproteinase may have prognostic value for determining whether individual chondrosarcomas are locally invasive or will metastasize. Furthermore, there may be a specific pattern of expression of matrix metalloproteinase and tissue inhibitor of metalloproteinase in chondrosarcomas that is related to local invasion and probability of metastasis. Sixteen paraffin-embedded archival specimens of tumors were examined. Six twenty-micrometer-thick sections were cut from each tumor, and the amounts of cDNA formed from the mRNA were determined with reverse transcription-polymerase chain reaction with use of novel primers for matrix metalloproteinase-1, matrix metalloproteinase-2, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2. The amounts of cDNA for the matrix metalloproteinases and their inhibitors were determined by chemiluminescence and band densitometry. The ratio of the amount of cDNA for matrix metalloproteinase-1 to that for its tissue inhibitor and the ratio of the amount of cDNA for matrix metalloproteinase-2 to that for its tissue inhibitor were calculated, and the results were compared with use of the Student t test, enabling log-rank analysis of Kaplan-Meier survival curves. These ratios as well as the age and gender of the patient; the grade, size, and location of the tumor; the type of adjuvant therapy; and the operative margins were examined for significance with use of stepwise logistic-regression analysis. The patients who had recurrent disease had a significantly higher (p < 0.003) ratio of matrix metalloproteinase-1 to tissue inhibitor of metalloproteinase-1 (mean, 0.939; range, 0.647 to 1.101) than the patients who were free of disease (mean, 0.703; range, 0.629 to 0.772). Moreover, there was a striking difference between the Kaplan-Meier survival curve associated with a high ratio (more than 0.8) and that associated with a low ratio (p = 0.0015). The mean ratio of matrix metalloproteinase-2 to tissue inhibitor of metalloproteinase-2 was 1.814 (range, 1.206 to 3.77) in the patients who had recurrent disease compared with 1.473 (range, 1.073 to 2.390) in those who were free of disease; this difference was not found to be significant, with the numbers available. Analysis of the survival curves indicated that a worse prognosis was associated with a high ratio, but again this relationship was not found to be significant. Regression analysis revealed that a high ratio of matrix metalloproteinase-1 to its tissue inhibitor was a moderately significant independent predictor of a poor outcome (alpha = 0.07). more...
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- 1998
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210. A Comparison of Accuracy Rates Between Open Biopsy, Cutting-Needle Biopsy, and Fine-Needle Aspiration Biopsy of the Breast: A 3-Year Experience
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Lester J. Layfield, Catherine M. Antley, Eoghan E. Mooney, and Shahla Masood
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Core needle ,medicine.medical_specialty ,Open biopsy ,medicine.diagnostic_test ,business.industry ,Gold standard (test) ,Aspiration cytology ,Fine-needle aspiration ,Oncology ,Cutting needle ,Biopsy ,Internal Medicine ,Medicine ,Surgery ,Radiology ,Medical diagnosis ,business - Abstract
The diagnostic accuracy of excisional biopsy is used as the “gold standard” for the diagnosis of breast nodules. In comparison studies involving the diagnostic accuracies of fine-needle aspiration cytology and cutting needle biopsy, the accuracy rate of open biopsy is often assumed to be 100%. While diagnostic accuracy rates are well reported for fine-needle aspiration (FNA) and large-gauge core needle biopsy, little data has been published documenting the accuracy of excisional biopsy. Hence, valid comparisons of relative diagnostic precision between the techniques are difficult to achieve. We report our experience with the sensitivity and specificity of open biopsy, cutting-needle biopsy and fine-needle aspiration biopsy over a three-year period. Between January 1992 and December 1994, histologic specimens from 412 open breast biopsies, and 17 non image guided Tru-cut® biopsies of palpable breast nodules were reviewed. These cases had either histologic follow-up (n= 388) or at least 2 years clinical follow-up (n= 25). Similarly, 450 FNAs were performed of which 215 had histologic study or cytologic follow-up. Within the 388 open biopsies with histologic follow-up, two false-negatives (sensitivity 99%) and one false-positive (specificity 99.5%) were detected based on subsequent biopsies or review of the initial material. No erroneous diagnoses were found in the 25 patients having only clinical follow-up. Among the 17 cutting needle-biopsies, two false-negatives (sensitivity 85%) were detected; no false-positives occurred (specificity 100%). One false-positive and five false-negatives were detected on follow-up of the 215 FNAs. This yielded a sensitivity of 96.2% and a specificity of 99.6%. Fine-needle aspiration compares favorably with both of these techniques, being inferior to open biopsy but of greater accuracy than cutting needle biopsy. These results demonstrate that care must be taken in using the histopathologic findings of open biopsy as the standard with which other methods of diagnosis are compared. more...
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- 1998
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211. Decay of Androgen Receptor Immunoreactivity in Archived Tissue By Using Monoclonal Antibody F39.4.1
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Michael S. Ballo, Rajesh C. Dash, and Lester J. Layfield
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Androgen receptor ,Medical Laboratory Technology ,medicine.drug_class ,business.industry ,medicine ,Anatomy ,Monoclonal antibody ,business ,Molecular biology - Published
- 1998
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212. Fine Needle Aspiration of Osteogenic Sarcoma Metastatic to the Lung
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Lester J. Layfield, Leslie G. Dodd, H. P. Mcadams, and Chiling Chai
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Pathology ,medicine.medical_specialty ,Histology ,Lung ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Malignancy ,Pathology and Forensic Medicine ,Metastasis ,Fine-needle aspiration ,medicine.anatomical_structure ,Cytopathology ,Biopsy ,medicine ,Osteosarcoma ,Sarcoma ,Radiology ,business - Abstract
BACKGROUND: Osteogenic sarcoma (OGS) is a relatively rare, highly malignant neoplasm of bone with a tendency to metastasize to the lung. Resection of pulmonary metastases in selected instances can increase survival and likelihood of a cure. To date, fine needle aspiration (FNA) of OGS had been well characterized in primary sites of bone and soft tissue. CASES: Four patients with a history of OGS presented with lung nodules suspected to be metastatic disease. All were evaluated initially by radiographically assisted FNA. In all cases FNA showed spindled or osteoblastlike cells. Two cases demonstrated stromal elements: chondroid or osteoid matrix in one case each of chondrobiastic and conventional OGS. All four cases had histologic confirmation of metastatic OGS in the form of subsequent surgical resection of the lung nodules. CONCLUSION: New pulmonary nodules in a patient with known malignancy is almost always metastatic disease. In a patient with a history of OGS, the diagnosis is extremely likely to be metastatic OGS, but a few other entities may occur. Although these entities are rare, their occasional occurrence could argue for preoperative confirmation of the lung lesion as malignant prior to subjecting the patient to pulmonary resection. Our findings show FNA features of OGS that have been previously observed in primary sites. These findings are specific enough to diagnose metastases if the patient has known primary OGS. more...
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- 1998
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213. Prognostic value of MIB-1 in advanced ovarian carcinoma as determined using automated immunohistochemistry and quantitative image analysis
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Billie-Jo M. Kerns, Debbi H. Conlon, J. Keith Thompson, Andrew Berchuck, Richard K. Dodge, Elizabeth Saria, and Lester J. Layfield
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medicine.medical_specialty ,Pathology ,Proliferation index ,Proliferative index ,business.industry ,Ovary ,General Medicine ,medicine.disease ,Gastroenterology ,medicine.anatomical_structure ,Oncology ,Internal medicine ,Ovarian carcinoma ,medicine ,Carcinoma ,Immunohistochemistry ,Surgery ,Stage (cooking) ,business ,Survival rate - Abstract
Background and Objectives The monoclonal antibody MIB-1 is an immunohistochemical marker reacting most strongly with cells in late S phase, G2, and M portions of the cell cycle. This antibody, reactive in formalin-fixed, paraffin-embedded tissue, allows the quantitation of a proliferation index (PI) in both current clinical cases and archival material using a computerized image analyzer (CIA). Methods Since many laboratories make use of automated immunohistochemistry (AIH), this study was performed to explore the technical feasibility of using AIH (Ventana ES 320) in combination with CIA (CAS 200) to evaluate MIB-1 PI as a prognostic marker as assessed by overall survival in 50 archival (formalin-fixed, paraffin-embedded), advanced stage primary ovarian carcinomas. Results Exploratory methods confirmed that 15% was a cutpoint that could dichotomize these 50 patients into two prognostic groups based on overall survival. The median survival of patients whose carcinoma had a high MIB-1 expression (⩾15%) was 16 months compared with 30 months in the patients whose tumors demonstrated low MIB-1 expression ( more...
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- 1997
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214. Intramammary lymph nodes: Cytologic findings and implications for fine-needle aspiration cytology diagnosis of breast nodules
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Leslie G. Dodd, Lester J. Layfield, Sharon Hirschcowitz, and Ben J. Glasgow
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education.field_of_study ,Pathology ,medicine.medical_specialty ,Histology ,business.industry ,Population ,Mammary gland ,General Medicine ,medicine.disease ,Pathology and Forensic Medicine ,Lymphoma ,medicine.anatomical_structure ,Cytopathology ,Cytology ,medicine ,Medullary carcinoma of the breast ,Intramammary lymph nodes ,education ,business ,Lymph node - Abstract
The recognition of intramammary lymphoid proliferations is important because smears of these proliferations would be judged as insufficient by several of the published criteria for specimen adequacy. Alternatively, some might be confused with medullary carcinoma of the breast or adenocarcinomas with a “single-cell” pattern. We found 19 intramammary lymphoid proliferations in a series of 887 fine-needle aspirates of palpable breast nodules. Six were lymphomas and 13 were benign intramammary lymph nodes. Smear cellularity ranged from scant to high, but in all cases, lymphocytes dominated the cell population. The cytology of intramammary lymph nodes and lymphoma did not differ from those occurring at other sites. Diagn. Cytopathol. 1997;17:223–229. © 1997 Wiley-Liss, Inc. more...
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- 1997
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215. Salivary gland lesions with a prominent lymphoid component: Cytologic findings and differential diagnosis by fine-needle aspiration biopsy
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Ben J. Glasgow, Chiling Chai, Lester J. Layfield, and Leslie G. Dodd
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Pathology ,medicine.medical_specialty ,Histology ,Salivary gland ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Warthin's tumor ,Pathology and Forensic Medicine ,Lymphoma ,medicine.anatomical_structure ,Fine-needle aspiration ,Cytopathology ,Biopsy ,medicine ,Differential diagnosis ,business ,Clear cell - Abstract
Fine-needle aspiration (FNA) is an accepted technique for the preoperative diagnosis of salivary gland nodules. The majority of salivary gland nodules are pleomorphic adenomas and offer little difficulty in diagnosis. Most diagnostically difficult lesions fall into one of four morphologic categories represented by squamous-cell-containing lesions, clear cell neoplasms, neoplasms with a prominence of stromal material, and lymphocyte-containing lesions. Herein, we describe our experience with a series of 61 histologically confirmed cases in which the smears contained a prominent or predominant number of lymphocytes. The differential diagnosis is discussed and points of diagnostic aid enumerated. Diagn. Cytopathol. 1997;17:183–190. © 1997 Wiley-Liss, Inc. more...
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- 1997
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216. Fine-needle aspiration of epithelioid malignant peripheral nerve sheath tumor (epithelioid malignant schwannoma)
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Lester J. Layfield, Leslie G. Dodd, and Sean P. Scully
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Pathology ,medicine.medical_specialty ,Histology ,integumentary system ,medicine.diagnostic_test ,business.industry ,Malignant peripheral nerve sheath tumor ,General Medicine ,Schwannoma ,medicine.disease ,Pathology and Forensic Medicine ,Nerve sheath tumor ,Fine-needle aspiration ,Cytopathology ,medicine ,Sarcoma ,Differential diagnosis ,business ,Epithelioid cell - Abstract
The epithelioid variant of malignant peripheral nerve sheath tumor (MPNST), also known as malignant epithelioid schwannoma, is a relatively rare and recently characterized clinicopathologic entity. The epithelioid variant of MPNST shares many clinical features with conventional MPNST but is characterized by different histologic and cytologic features. These include a distinctive nesting pattern and an abundance of cytoplasm not seen in histology of conventional nerve sheath tumors. Cytologically, the epitheliod variant shows a propensity to cellular discohesiveness and a plasmacytoid or epitheliod appearance that is in contradistinction to the spindled appearance of the usual MPNST. Herein, we report our experience with fine-needle aspiration (FNA) of two epithelioid malignant schwannomas and discuss the FNA cytologic differential diagnosis. Diagn. Cytopathol. 1997;17:200–204. © 1997 Wiley-Liss, Inc. more...
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- 1997
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217. Fine-needle aspiration biopsy of salivary duct carcinoma: Report of five cases
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Shannon Kratzer, Carol C. Eisenhut, John D. Feczko, Pýnar Fýrat, Lester J. Layfield, Michael D. Glant, and F.R.C.P. . Harvey Cramer M.D.
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Pathology ,medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,Salivary gland ,business.industry ,General Medicine ,Ductal carcinoma ,medicine.disease ,Pathology and Forensic Medicine ,Salivary duct carcinoma ,Fine-needle aspiration ,medicine.anatomical_structure ,Cytopathology ,Biopsy ,medicine ,Carcinoma ,Adenocarcinoma ,business - Abstract
Salivary duct carcinoma is a high grade malignancy which histologically strongly resembles ductal carcinoma of the breast. The findings from five cases of histologically proven salivary duct carcinoma sampled by preoperative fine-needle aspiration (FNA) cytology are presented. Characteristic cytomorphologic features include cohesive clusters and flat sheets of epithelial cells which display a cribriform pattern with eccentrically located, hyperchromatic nuclei, abundant finely granular cytoplasm, and necrosis in the smear background. more...
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- 1997
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218. Prognostic factors for fibromatoses: A correlation of proliferation index, estrogen receptor, p53, retinoblastoma, andsrc gene products and clinical features with outcome
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J. M. Madden, B. J. Kerns, Lester J. Layfield, and E. J. Moffatt
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Pathology ,medicine.medical_specialty ,Proliferation index ,Retinoblastoma ,medicine.drug_class ,business.industry ,Fibromatosis ,Estrogen receptor ,General Medicine ,medicine.disease ,Lesion ,Oncology ,Estrogen ,medicine ,Immunohistochemistry ,Surgery ,medicine.symptom ,Fibroma ,business - Abstract
Background: The aggressiveness of fibromatoses is difficult to predict by morphologic analysis. Additional prognostic markers would be helpful for clinical management. Materials and Methods: Proliferation index (MIB-1), p53, src, retinoblastoma gene protein products, estrogen receptor level, site and depth of lesion were correlated with incidence of recurrence in 52 patients. Superficial (47) and deep (5) fibromatoses were studied. Anatomic sites included the extremities, head, neck, trunk, and pelvis. Results: Twenty (38%) lesions recurred locally. All five deep lesions recurred, but only 32% of superficial tumors recurred. Mean proliferation index for recurrent lesions was 0.82% and 0.73% for nonrecurrent fibromatoses ; no significant differences were observed. Five recurrent lesions (25%) expressed estrogen receptor >5 fmol/mg as did 31% (10 of 32) of the nonrecurrent lesions. None of the tested specimens expressed src gene product. Eight of the lesions which recurred (40%) contained p53, but only five nonrecurring tumors (16%) expressed p53. One of five deep lesions (20%) expressed p53 and 26% (12 of 47) of superficial tumors expressed p53. Forty-six percent (6 of 13) of recurrent lesions tested were retinoblastoma protein product negative, but only 33.3% (7 of 21) of nonrecurring tumors were retinoblastoma protein product negative. Conclusions: Only p53 and depth of lesion were of statistical value for the prediction of recurrence. more...
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- 1997
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219. Fine-needle aspiration cytology findings in a case of aggressive angiomyxoma: A case report and review of the literature
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Leslie G. Dodd and Lester J. Layfield
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Myxoid liposarcoma ,Pathology ,medicine.medical_specialty ,Histology ,Open biopsy ,Stromal cell ,Groin ,business.industry ,General Medicine ,medicine.disease ,Pathology and Forensic Medicine ,Aggressive angiomyxoma ,medicine.anatomical_structure ,Cytopathology ,Medicine ,Differential diagnosis ,business ,Angiomyxoma - Abstract
Aggressive angiomyxomas are uncommon but distinct soft-tissue neoplasms occurring predominantly in the pelvis and peritoneum of females, but they have occasionally been reported in association with inguinal hernias in males. Histologically, these neoplasms are characterized by a proliferation of spindle- or stellate-shaped cells widely separated by loose myxoid stroma in which is dispersed a prominent vascular component. The vascular component is comprised of large, thick-walled vessels that generally to not show an arborizing pattern. Mitotic activity has been exceedingly low in the cases reported. Because of their occurrence within the groin, these lesions may undergo fine-needle aspiration (FNA). Cytologic examination of this material will reveal hypocellular smears containing scattered spindle cells with bipolar cytoplasmic processes, as well as bland stellate cells. The nuclei are fusiform to oval with a bland chromatin pattern. The stromal cells lie in a background of watery myxoid material. While specific diagnosis by FNA is not possible, the recognition of this cytologic appearance should exclude lymphoproliferative processes as well as metastatic disease from the differential diagnosis. Careful attention to cytologic detail should also help exclude certain other myxoid neoplasms, especially myxoid liposarcoma. Once the myxoid stromal nature of the proliferation is recognized, a differential diagnosis of myxoid lesions can be considered along with a recommendation for open biopsy to establish the definitive diagnosis. more...
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- 1997
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220. Intratumoral heterogeneity in primary breast carcinoma: Study of concurrent parameters
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Lester J. Layfield, Leslie G. Dodd, B. J. Kerns, and Richard K. Dodge
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Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Mammary gland ,General Medicine ,Biology ,Ductal carcinoma ,medicine.disease ,Flow cytometry ,medicine.anatomical_structure ,Oncology ,Carcinoma ,medicine ,Immunohistochemistry ,Surgery ,Feulgen stain ,Ploidy ,Breast carcinoma - Abstract
Background and objective Intratumoral heterogeneity for prognostic factors (ploidy, proliferation, hormone receptor positivity) has been demonstrated in primary breast carcinoma by both flow cytometric and image analysis methods. Previously, heterogeneity in tumors had been demonstrated for only singular parameters. Our objective, using maps of tumors in which discrete regions can be analyzed simultaneously for DNA index (DI) and proliferative activity, was to demonstrate heterogeneity with respect to two parameters and to determine whether any interparametric relationships existed. Methods We analyzed 25 cases of archived, paraffin-embedded breast carcinoma (ductal) for Feulgen stain DNA analysis and MIB-1 immunohistochemistry using the CAS 200 Image Cytometer. For each tumor, four discrete regions were analyzed including tumor-host tissue interface sectors. Results Of 25 cases, 19 (76%) were homogeneously diploid or near-diploid aneuploid, and 6 (24%) were heterogeneous. Within the heterogeneous group, all cases had at least one diploid and one or more aneuploid populations from separate discrete regions. Five of six DI heterogeneous tumors displayed diploid values for the overall measurements of the respective tumors, based on analysis of 200 or more nuclei. Eight of 25 cases (32%) showed significant measurable variation for MIB-1 proliferative activity in various sectors of tumor. All the MIB-1 heterogeneous tumors, with one exception, were homogeneously diploid. Conclusions These findings demonstrate that (1) heterogeneity is present with respect to DI and proliferative activity in breast carcinoma and is relatively common, (2) tumors homogeneous for one parameter may be heterogeneous for another, and (3) heterogeneity for proliferative activity is more common in homogeneously diploid tumors than in heterogeneous/aneuploid tumors. more...
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- 1997
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221. What constitutes an adequate smear in fine-needle aspiration cytology of the breast?
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E M B Eoghan Mooney, Alice Coogan, Sharon Hirschowitz, Lester J. Layfield, and Ben Glasgow
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Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,Cell Count ,Diagnosis, Differential ,Breast Diseases ,Predictive Value of Tests ,Cytology ,medicine ,Humans ,Sampling (medicine) ,Medical diagnosis ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,medicine.disease ,Surgery ,Fine-needle aspiration ,Oncology ,Cytopathology ,Predictive value of tests ,Adenocarcinoma ,Female ,Radiology ,Differential diagnosis ,business - Abstract
BACKGROUND The false-negative diagnosis is a major clinical concern and a significant cause of litigation in fine-needle aspiration cytology of breast lesions. A significant number of false-negative diagnoses may be due to inadequate sampling of these lesions. Little information is available in the literature about what constitutes an adequate specimen, and the few publications that address this issue propose criteria based on anecdotal information. Recommendations vary widely and may or may not take clinical findings into account. METHODS The authors studied a subgroup of 183 cases with known outcome, drawn from a series of 1779 cases, to determine the minimum number of cell clusters necessary to ensure that adequate cellular material was present for accurate diagnosis. The series included 21 cases cytologically diagnosed as false-negative, 75 cases that had been correctly identified as benign, 47 cases cytologically designated as atypical, and 40 cases that on initial review had been correctly identified as malignant. In semiblind fashion, the smears from each case were assigned to low, medium, and high cellularity categories. Low cellularity was defined as 10 or fewer cell clusters, moderate cellularity was defined as 11-30 clusters, and high cellularity was defined as more than 30 clusters. A cell cluster was defined as five or more cells. Within the low cellularity group, exact numbers of cell clusters and the presence of individual cells were recorded. The presence of bipolar cells was used as an adjunct criterion for specimen adequacy, and the bipolar cells in each of 10 × 200 fields were counted. Cellularity was then correlated with diagnostic accuracy. RESULTS Using a cutpoint of a cumulative score of 6 or more cell clusters or the prominence of bipolar cells (≥10 in each of 10 medium-power, ×200 fields) for assessment of specimen adequacy, a false-negative rate of 1.5%, associated with an unsatisfactory rate of 20.2%, was obtained. CONCLUSIONS Based on the data gathered in this study, the authors believe that the sampling false-negative and unsatisfactory rates can be minimized by selecting a cutpoint for satisfactory smears at a level of 6 or more cell clusters (cumulative total) or the presence ≥ 10 intact bipolar cells per 10 medium-power fields (×200). Use of these criteria will decrease the false-negative rate of sampling in epithelial lesions of the breast. A false-negative rate of approximately 1.5% was obtained in association with an unsatisfactory rate of 20.2%. Using a cutpoint of 1 or more cell clusters, a false-negative rate of 2.1%, associated with an unsatisfactory rate of 13.7%, was obtained. [See editorials on pages 1-2, 3-5, this issue.] Cancer (Cancer Cytopathol) 1997; 81:16-21. © 1997 American Cancer Society. more...
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- 1997
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222. Prognostic Markers in Chondrosarcoma: Evaluation of Cell Proliferation and of Regulators of the Cell Cycle
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Lester J. Layfield, John M. Harrelson, and Sean P. Scully
- Subjects
Pathology ,medicine.medical_specialty ,Oncogene ,Tumor suppressor gene ,Proliferation index ,business.industry ,Cell cycle ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,lcsh:RC254-282 ,Oncology ,medicine ,Immunohistochemistry ,Radiology, Nuclear Medicine and imaging ,Chondrosarcoma ,business ,Grading (tumors) ,Survival analysis ,Research Article - Abstract
Purpose. The prognosis, treatment principles and prediction of clinical outcome of patients with chondrosarcoma currently rest on histologic grading which is somewhat ambiguous due to dif® culty in pathologic interpretation of this neoplasm. Immunohistochemistry, ¯ ow cytometry and oncogene/tumor suppressor gene expression have been examined as alternative indices to predict the biologic behavior of these tumors. Because of partial successes obtained withow cytometry and because of the improvement in predicting recurrence offered by examining the S-phase fraction, we undertook the current study to determine if expression of speci® c regulators of the cell cycle would act as prognostic indicators for these patients. Subjects/methods. We examined archival pathologic specimens from 39 patients with at least 2 years' clinical follow-up for the presence of p53, Rb, src and MIB-1 by immunohistochemistry and correlated this with clinical histories and incidence of recurrence. Results. While Rb, p53 and src gene products were identi® ed to a variable extent in these specimens, there was no prognostic signi® cance to their expression. In contrast, MIB-1, an epitope expressed only during semiconservative replication and an accepted marker of cell proliferation, served as a signi® cant prognostic indicator. MIB-1 staining was present in 14.5% of tumor cells in all specimens (range 0± 59%). When MIB-1 staining was examined with respect to disease recurrence, there was a statistically signi® cant association between staining and histologic grade ( p , 0.05) as well as event-free survival ( p , 0.02). Comparing survival curves strati® ed by MIB-1 expression, there was a signi® cant decrease in event-free survival associated with increasing MIB-1 indices ( p, 0.003). Covariates that were associated with event-free survival include histologic grade ( p 5 0.025) and stage (Musculoskeletal Tumor Society) ( p 5 0.014). There was no statistical association with patient age ( p5 0.15), tumor size ( p 5 0.47), tumor histology ( p 5 0.62) or anatomic location (p 5 0.316). Discussion. These results indicate that determination of the proliferation index by MIB-1 immunostaining may serve as a useful adjunct to current histopathologic classi® cation. Patients with a high proliferation index may bene® t from established adjuvant therapies or experimental approaches including immunotherapy or biologic modulation. more...
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- 1997
223. Cytologic findings in tenosynovial giant cell tumors investigated by fine-needle aspiration cytology
- Author
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Leslie G. Dodd, Sean P. Scully, Elizabeth J. Moffatt, John M. Harrelson, and Lester J. Layfield
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education.field_of_study ,Pathology ,medicine.medical_specialty ,Histology ,business.industry ,Population ,General Medicine ,Aneurysmal bone cyst ,Chondroblastoma ,medicine.disease ,Pathology and Forensic Medicine ,Cytopathology ,Giant cell ,medicine ,Sarcoma ,Giant Cell Tumors ,business ,education ,Giant-cell tumor of bone - Abstract
Tenosynovial giant cell tumor is a relatively common benign proliferation affecting the articular and periarticular soft tissues. Cytologic findings on smears obtained by fine-needle aspiration are rather characteristic and include a mixture of oval or polygonal mononuclear cells showing vacuolation and/or pigment deposition along with a population of multinucleated giant cells. Separation from other giant cell lesions including true giant cell tumor of bone, chondroblastoma, aneurysmal bone cyst, and granulomatous inflammation must be made. Careful attention to the cytologic findings and correlation with clinical and radiographic data should result in the appropriate diagnosis of tenosynovial giant cell tumor in most cases. more...
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- 1997
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224. Endoscopic Brush Cytology of the Upper Urinary Tract
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Cary N. Robertson, William W. Johnston, Lester J. Layfield, and Leslie G. Dodd
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medicine.medical_specialty ,Histology ,business.industry ,Carcinoma in situ ,Urology ,General Medicine ,medicine.disease ,Pathology and Forensic Medicine ,Surgery ,Transitional cell carcinoma ,medicine.anatomical_structure ,Ureter ,Cytopathology ,Cytology ,medicine ,Carcinoma ,business ,Renal pelvis ,Upper urinary tract - Abstract
OBJECTIVE: To evaluate the efficacy of endoscopic brush cytology in diagnosing transitional cell carcinoma of the upper urinary tract. STUDY DESIGN: Sixty-three endoscopic brush cytology specimens from 48 patients were compared with corresponding cytologic specimens obtained by irrigation and catheterization as well as Endoscopic brush histologic specimens. Results: Twenty patients (25 brushes) had histologically documented transitional cell carcinoma (TCC) or carcinoma in situ (CIS) of either the ureter or renal pelvis. Among these, 8 (32%) of the brush samples were reported as positive for TCC, 10 (40%) atypical or suspicious, and 7 (28%) negative. The seven negative cases were ultimately shown to be low grade (I-II/IV) TCC. Combining atypical and positive diagnoses, the calculated sensitivity for diagnosis of TCC by this technique was 72%. The irrigations or catheterized urines from these same patients yielded lower sensitivity, 48%, and detected only higher grade lesions. Ten patients were proven histologically to have nonneoplastic disease (hydroureter, obstruction, inflammation). Sixteen of the 17 brush specimens from these patients were negative, resulting in a specificity of 94%. In the remaining 18 patients (21 brushes) there were 17 negatives and 4 atypicals. Concomitant cytology supported the brush diagnosis in all but one sample. CONCLUSION: Brush cytology is a specific and more sensitive sampling method than irrigation or catheterized urine in detecting TCC of the upper urinary tract. Brush cytology does not appear to be successful in diagnosing dysplasia or CIS. As with urinary cytology in general, the technique is less effective in diagnosing low grade (I and II) lesions. more...
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- 1997
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225. Cytologic features of pulmonary metastasis from a granulosa cell tumor diagnosed by fine-needle aspiration: A case report
- Author
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Katharine Liu, Alice C. Coogan, and Lester J. Layfield
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endocrine system ,Pathology ,medicine.medical_specialty ,Histology ,Lung ,medicine.diagnostic_test ,business.industry ,Granulosa cell ,Respiratory disease ,General Medicine ,medicine.disease ,Pathology and Forensic Medicine ,Metastasis ,Fine-needle aspiration ,medicine.anatomical_structure ,Cytopathology ,medicine ,Differential diagnosis ,business ,Chest radiograph - Abstract
We report on a case of a granulosa cell tumor of the ovary metastatic to the lung and diagnosed by fine-needle aspiration. The patient was a 70-yr-old woman who was diagnosed with a granulosa cell tumor of the ovary 17 yr previously. She subsequently developed abdominal metastases and received several cycles of chemotherapy. A 0.5-cm right upper lobe pulmonary nodule was found on a routine chest radiograph and subsequent computerized tomography scan. Aspiration cytology of this pulmonary nodule demonstrated small, relatively uniform neoplastic cells with nuclear grooves and indentations consistent with a granulosa cell tumor. The differential diagnosis of granulosa cell tumors from other metastatic and pulmonary lesions is reviewed. more...
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- 1997
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226. Proliferative Index Determination in Prostatic Carcinoma Tissue: Is There Any Additional Prognostic Value Greater Than That of Gleason Score, Ploidy and Pathological Stage?
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David F. Paulson, Lester J. Layfield, Veronika Hars, and Lance J. Coetzee
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Adult ,Male ,Prognostic variable ,Pathology ,medicine.medical_specialty ,Proliferative index ,Urology ,medicine.medical_treatment ,Prostate cancer ,Prostate ,Carcinoma ,medicine ,Humans ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Ploidies ,Prostatectomy ,business.industry ,Prostatic Neoplasms ,Middle Aged ,Prognosis ,medicine.disease ,Prostate-specific antigen ,medicine.anatomical_structure ,Multivariate Analysis ,Regression Analysis ,Adenocarcinoma ,business ,Cell Division - Abstract
The proliferative index was evaluated as an additional prognostic variable in 244 radical prostatectomy specimens from patients with prostate cancer. This study was done on the grounds that this variable has shown some promise as a prognostic tool in some other carcinomas, for example breast cancer.The proliferative index was evaluated in 244 patients undergoing radical prostatectomy for clinically localized disease between January 1988 and August 1994. Proliferative index was determined using the Ki-67 antibody on fresh frozen tissue and MIB-1 on paraffin embedded tissues. Patients were divided into 2 groups based on a proliferative index of less than 1 (185) or 1 or greater (59). Of the patients 49 (20%) had biochemical failure (median 23 months to progressive prostate specific antigen elevation of 0.5 ng./ml. or more). Those whose treatment failed were also divided into 2 groups according to proliferative index: 32 of 185 (18%) with an index of less than 1 and 17 of 59 (27%) with an index of 1 or more. Gleason score and deoxyribonucleic acid ploidy status were also evaluated in all patients and compared in multivariate regression analysis. Operative specimens were categorized as organ confined, specimen confined or margin positive.The distribution according to margin status in the 2 groups (proliferative index less than 1 and 1 or more) was 40 versus 60% for organ confined, 67 versus 33% for specimen confined and 72 versus 28% for margin positive disease, respectively. The distribution of time to treatment failure in the 2 groups was not markedly different: 7.2 versus 9.4 months for margin positive, 10 versus 14.5 months for specimen confined and 8.5 versus 12 months for organ confined cancer, respectively.Multivariate analysis demonstrated that, although deoxyribonucleic acid ploidy seemed to correlate with more advanced disease, only Gleason sum and pathological T stage reached statistical significance when evaluated against time to treatment failure. A high proliferative index added little above the more traditional prognostic indicators of Gleason score, pathological stage and ploidy. Therefore, we question the value of proliferative index as a prognostic indicator using the aforementioned methodology in prostate cancer. more...
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- 1997
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227. Juvenile granulosa cell tumors: immunoreactivity for CD99 and Fli-1 and EWSR1 translocation status: a study of 11 cases
- Author
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Elke A, Jarboe, Sharon L, Hirschowitz, Katherine B, Geiersbach, Michelle L, Wallander, Sheryl R, Tripp, and Lester J, Layfield
- Subjects
Ovarian Neoplasms ,Microfilament Proteins ,RNA-Binding Proteins ,Receptors, Cytoplasmic and Nuclear ,12E7 Antigen ,Immunohistochemistry ,Translocation, Genetic ,Antigens, CD ,Biomarkers, Tumor ,Trans-Activators ,Humans ,Calmodulin-Binding Proteins ,Female ,RNA-Binding Protein EWS ,Child ,Cell Adhesion Molecules ,In Situ Hybridization, Fluorescence ,Granulosa Cell Tumor - Abstract
The accurate diagnosis of a juvenile granulosa cell tumor (JGCT) can be challenging, as these neoplasms often exhibit morphologic features that overlap other ovarian neoplasms. In addition, the immunohistochemical profile exhibited by JGCT is fairly nonspecific and typically includes reactivity for CD99. Recently, we noted that JGCTs can show immunohistochemical expression of Fli-1, a transcription factor expressed by Ewing sarcoma, a neoplasm that is occasionally in the differential diagnosis of JGCT. We evaluated a series of JGCTs to determine whether Fli-1 is commonly expressed by these tumors and whether they demonstrate chromosomal arrangements in EWSR1. Cases diagnosed as JGCT (n=11) were immunohistochemically evaluated for expression of Fli-1 and CD99. Fluorescence in situ hybridization was performed on all cases to search for chromosomal rearrangements in EWSR1. All 11 of our cases exhibited positive immunohistochemical staining for Fli-1 and CD99. None of the cases demonstrated rearrangement in EWSR1 by fluorescence in situ hybridization. In cases of JGCT that cannot be reliably distinguished from Ewing sarcoma based on morphology and immunohistochemistry alone, fluorescence in situ hybridization testing for EWSR1 rearrangements seems to be a useful diagnostic adjunct for their separation. more...
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- 2013
228. Clinical evaluation, imaging studies, indications for cytologic study, and preprocedural requirements for duct brushing studies and pancreatic FNA: the Papanicolaou Society of Cytopathology recommendations for pancreatic and biliary cytology
- Author
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Lester J. Layfield, Andrew S. Field, Martha B. Pitman, Joseph Romagnuolo, Douglas G. Adler, Mohammad A. Al-Haddad, Akram M. Shaaban, Nipun B. Merchant, C. Max Schmidt, Britt-Marie Ljung, James S. Barthel, and Diane M. Simeone more...
- Subjects
Endoscopic ultrasound ,Diagnostic Imaging ,medicine.medical_specialty ,Histology ,Biopsy, Fine-Needle ,Papanicolaou stain ,Pathology and Forensic Medicine ,Cytology ,medicine ,Humans ,Biliary Tract ,Pancreas ,Societies, Medical ,Ultrasonography ,medicine.diagnostic_test ,Bile duct ,business.industry ,General Medicine ,Cell Biology ,medicine.anatomical_structure ,Fine-needle aspiration ,Cytopathology ,Biliary tract ,Radiology ,business - Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing, and post-biopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings, and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed. more...
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- 2013
229. Fine-needle aspiration cytology for the diagnosis of metastatic melanoma: systematic review and meta-analysis
- Author
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Brian J, Hall, Robert L, Schmidt, Rohit R, Sharma, and Lester J, Layfield
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Skin Neoplasms ,ROC Curve ,Lymphatic Metastasis ,Humans ,Reproducibility of Results ,Lymph Nodes ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Melanoma ,Skin ,Ultrasonography - Abstract
To perform a thorough review and meta-analysis of studies that have shown non-image-guided fine-needle aspiration cytology (FNAC) to be highly sensitive and specific for assessing questionable metastatic melanoma to lymph nodes.MEDLINE and Scopus were searched for potentially relevant articles with a search string including the words "melanoma" and "fine needle." All relevant articles were screened by two authors (B.J.H. and R.L.S.). Full articles were screened for extractable data, and the data was pooled for analysis.Of 978 unique studies found, 10 (5,518 cases) met our inclusion criteria. In a pooled analysis of palpation and ultrasound-guided fine-needle aspirations, the area under the receiver operating characteristic curve was 0.99 (95% confidence interval [CI], 0.99-1.00). The summary estimates for the sensitivity and specificity were 0.97 (95% CI, 0.95-0.98) and 0.98 (95% CI, 0.98-1.00), respectively.With a sensitivity and specificity of 0.97 and 0.99, the overall diagnostic accuracy of FNAC for metastatic melanoma is quite high, and with a positive and negative likelihood ratio of 58 and 0.03, FNAC for metastatic melanoma should be the first-line option in a patient with a clinically suspected mass and a history of melanoma. more...
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- 2013
230. Critical values: has their time arrived for cytopathology?
- Author
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Lester J, Layfield
- Subjects
Diagnosis, Differential ,Pathology, Clinical ,Time Factors ,Reference Values ,Critical Illness ,Cytological Techniques ,Humans - Published
- 2013
231. Giant cell tumors of the musculoskeletal system
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Julia R. Crim, Lucio Palombini, Carlos W. M. Bedrossian, and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Giant Cell Tumors ,business - Published
- 2013
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232. Epithelioid and polygonal cell tumors of bone and soft tissue
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Lucio Palombini, Julia R. Crim, Carlos W. M. Bedrossian, and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,Chemistry ,Polygonal cell ,medicine ,Soft tissue - Published
- 2013
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233. Principles and practice for biopsy diagnosis and management of musculoskeletal lesions
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Lester J. Layfield, Lucio Palombini, Carlos W. M. Bedrossian, and Julia R. Crim
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Small volume ,Soft tissue ,Young age ,Fine-needle aspiration ,Orthopedic surgery ,Biopsy ,medicine ,Tissue diagnosis ,Histopathology ,Radiology ,business - Abstract
INTRODUCTION TO THE DIAGNOSIS OF MUSCULOSKELETAL LESIONS Fine needle aspiration and core biopsy are used at some oncology centers as the initial technique to obtain a tissue diagnosis for mass lesions occurring within the musculoskeletal system. A majority of such lesions are in actuality metastatic deposits from a primary malignancy arising elsewhere. Metastatic neoplasms usually present little difficulty in diagnosis. Primary lesions of the musculoskeletal system are a significantly greater diagnostic challenge and many authorities in histopathology of bone and soft tissue tumors have recommended against the use of small biopsy techniques for the diagnosis of these lesions. The resistance to the use of small volume specimens, especially fine needle aspiration (FNA), results from a combination of factors including the relative rarity of these lesions, the potential for radical deforming surgery and the young age of the patients in which many of these lesions occur. Musculoskeletal sarcomas account for less than 1% of all malignant neoplasms. The infrequency of these tumors results in limited experience with their morphologic appearances among surgical pathologists and cytopathologists except for those practicing at orthopedic oncology centers. Contributing to this reduction in the utilization of small biopsy procedures is the relatively high percentage of benign proliferations (pseudosarcomas) closely resembling true sarcomas. An additional issue which has slowed the implementation of FNA for the investigation of musculoskeletal neoplasms is concern that the technique may not procure sufficient sample to obtain reliable results with a variety of ancillary techniques including immunohistochemistry and molecular diagnostics. more...
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- 2013
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234. Lipomatous tumors
- Author
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Lucio Palombini, Lester J. Layfield, Julia R. Crim, and Carlos W. M. Bedrossian
- Subjects
Myxoid liposarcoma ,Pathology ,medicine.medical_specialty ,Angiolipoma ,business.industry ,Liposarcoma ,Lipoma ,medicine.disease ,medicine ,Lipoblastoma ,Pleomorphic lipoma ,Differential diagnosis ,business ,Hibernoma - Published
- 2013
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235. Vascular tumors of bone and soft tissue
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Julia R. Crim, Lucio Palombini, Lester J. Layfield, and Carlos W. M. Bedrossian
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Hemangiopericytoma ,medicine.medical_specialty ,Pathology ,business.industry ,Capillary hemangioma ,Granulation tissue ,Soft tissue ,medicine.disease ,Hemangioendothelioma ,Hemangioma ,medicine.anatomical_structure ,Medicine ,Angiosarcoma ,Radiology ,business ,Epithelioid hemangioendothelioma - Published
- 2013
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236. Musculoskeletal Cytohistology
- Author
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Lester J. Layfield, Carlos W. Bedrossian, Julia R. Crim, and Lucio Palombini
- Abstract
Each volume in this richly illustrated series, sponsored by the Papanicolaou Society of Cytopathology, provides an organ-based approach to the cytological and histological diagnosis of small tissue samples. Benign, pre-malignant and malignant entities are presented in a well-organized and standardized format, with high-resolution color photomicrographs, tables, tabulated specific morphologic criteria and appropriate ancillary testing algorithms. Example vignettes allow the reader to assimilate the diagnostic principles in a case-based format. This volume describes the cytologic, small core biopsy, immunohistochemical and molecular diagnostic features of musculoskeletal lesions. It provides the cytopathologist and histopathologist with a comprehensive survey of diagnostic approaches and diagnostic features for benign and malignant lesions. Each chapter contains a detailed summary of differential diagnostic features, supported by high-quality images and case studies. The print edition includes a CD-ROM offering all images in a downloadable format. With over 500 photomicrographs, this is an important resource for practising pathologists and residents in pathology. more...
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- 2013
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237. Cystic lesions of bone and soft tissue
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Lucio Palombini, Lester J. Layfield, Julia R. Crim, and Carlos W. M. Bedrossian
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Cystic lesion ,Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Soft tissue ,business - Published
- 2013
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238. Cartilaginous neoplasms of bone and soft tissue
- Author
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Lucio Palombini, Julia R. Crim, Carlos W. M. Bedrossian, and Lester J. Layfield
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business.industry ,Soft tissue ,Medicine ,Anatomy ,business - Published
- 2013
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239. Spindle cell tumors of bone and soft tissue in infants and children
- Author
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Julia R. Crim, Lucio Palombini, Carlos W. M. Bedrossian, and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,Fibromatosis ,medicine ,Osteosarcoma ,Soft tissue ,Fibromatosis colli ,Giant Cell Tumors ,Nodular fasciitis ,Chondroblastoma ,Biology ,medicine.disease ,Rhabdomyosarcoma - Published
- 2013
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240. Spindle cell tumors of the musculoskeletal system characteristically occurring in adults
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Lester J. Layfield, Julia R. Crim, Carlos W. M. Bedrossian, and Lucio Palombini
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Neurofibromatosis type I ,Hemangiopericytoma ,Neurilemoma ,Pathology ,medicine.medical_specialty ,business.industry ,Fibromatosis ,Malignant peripheral nerve sheath tumor ,Nodular fasciitis ,Anatomy ,medicine.disease ,medicine ,Neurofibroma ,Differential diagnosis ,business - Published
- 2013
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241. Osseous tumors of bone and soft tissue
- Author
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Lucio Palombini, Lester J. Layfield, Julia R. Crim, and Carlos W. M. Bedrossian
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Pathology ,medicine.medical_specialty ,business.industry ,medicine ,Soft tissue ,business - Published
- 2013
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242. Small round cell neoplasms of bone and soft tissue
- Author
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Lucio Palombini, Lester J. Layfield, Carlos W. M. Bedrossian, and Julia R. Crim
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Pathology ,medicine.medical_specialty ,medicine ,Round cell ,Soft tissue ,Biology - Published
- 2013
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243. Pleomorphic sarcomas of bone and soft tissue
- Author
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Lester J. Layfield, Lucio Palombini, Julia R. Crim, and Carlos W. M. Bedrossian
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Pathology ,medicine.medical_specialty ,business.industry ,medicine ,Soft tissue ,business - Published
- 2013
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244. Malignancy risk associated with diagnostic categories defined by the Papanicolaou Society of Cytopathology pancreaticobiliary guidelines
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Lester J, Layfield, Leslie, Dodd, Rachel, Factor, and Robert L, Schmidt
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Diagnosis, Differential ,Pancreatic Neoplasms ,Biliary Tract Neoplasms ,Risk Factors ,Practice Guidelines as Topic ,Humans ,Precancerous Conditions ,Societies, Medical - Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the predominant method for obtaining a preoperative tissue diagnosis for pancreatic lesions suspicious for malignancy. The diagnostic sensitivity and specificity of EUS-FNA are well documented, but malignancy risk associated with the diagnostic categories proposed by the Papanicolaou Society of Cytopathology is poorly defined.The records of the Departments of Pathology at Duke University and the University of Utah were searched for all cases of EUS-FNA performed for the investigation of pancreatic lesions. All cases with follow-up surgical diagnosis or greater than 3 years of clinical follow-up were selected. Cytologic diagnostic categories were "nondiagnostic," "benign," "atypical (not otherwise specified)," "suspicious for malignancy," "neoplasm," and "malignant." Correlation of cytologic diagnosis with surgical and/or clinical follow-up was made and risk of malignancy calculated for each category.Three hundred seventeen EUS-FNAs with adequate surgical or clinical follow-up were obtained. Risk of malignancy for nondiagnostic specimens was 21%;, benign specimens, 13%; atypical cases, 74%; suspicious for malignancy, 82%; the neoplasm category, 14%; and the malignant category, 97%The cytologic categories proposed by the Papanicolaou Society of Cytopathology demonstrate an increasing risk for malignancy extending from benign to malignant. Aspirates designated benign have the lowest risk of malignancy (13%) and aspirates designated malignant the highest (97%). The proposed categorization scheme stratifies risk for malignancy giving useful information to clinicians treating patients with pancreatic lesions. more...
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- 2013
245. Pancreaticobiliary tract cytology: Journey toward 'Bethesda' style guidelines from the Papanicolaou Society of Cytopathology
- Author
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Richard M. DeMay, Lester J. Layfield, Martha B. Pitman, and Vinod B. Shidham
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Gynecology ,medicine.medical_specialty ,Intraductal papillary mucinous neoplasm ,business.industry ,lcsh:Cytology ,General surgery ,Papanicolaou stain ,Guideline ,Neuroendocrine tumors ,medicine.disease ,Malignancy ,Small-cell carcinoma ,Bethesda system for reporting thyroid cytopathology ,Pathology and Forensic Medicine ,Editorial ,Cytopathology ,medicine ,lcsh:QH573-671 ,business - Abstract
The current series of articles related to the Papanicolaou Society of Cytopathology (PSC) guidelines for pancreaticobiliary cytology are the product of significant efforts by many experts working on different PSC guidelines committees.[1] The PSC guidelines for cytologic interpretation and reporting of variety of body site specimens have been described previously.[2,3,4,5,6] These are comparable to the guidelines from the National Cancer Institute for cervical cytology[7] and fine needle aspiration cytology of breast and thyroid.[8,9] Most of these systems are designed to stratify the risk of malignancy with diagnostic categories for guiding appropriate management algorithms. The current guidelines[10,11,12,13,14] follow the strategies comparable to the Bethesda System for Reporting Thyroid Cytopathology. The guidelines not only consider diagnostic categories and criteria, but also attempt to provide details on other aspects including techniques for obtaining specimens, which patient would benefit most from cytologic evaluation, information on ancillary testing, and patient follow-up/management. The scheme addresses the wide spectrum of approaches to acquire diagnostic material for cytopathologic evaluation from a variety of pancreaticobiliary lesions. A six-tiered system is recommended for the standardized nomenclature in pancreaticobiliary cytology. The categories proposed are: Non-diagnostic, negative, atypical, neoplastic (benign or other), suspicious, and positive.[12] “Atypical” and “suspicious” categories have relatively well reported malignancy risks.[15,16] Potentially, the most challenging and controversial category is “neoplastic (benign and other)” with the widest range of interpretations. The entities included in this category range from innocuous lesions such as benign cystic neoplasms (serous cystadenoma) to others like pre-malignant mucinous cysts (cystic mucinous neoplasm and intraductal papillary mucinous neoplasm), low-grade well-differentiated neuroendocrine tumors (NETs), and solid-pseudopapillary neoplasms. The premalignant mucinous cysts without unequivocal features of malignancy would fall in this category with very wide management options.[17] The NETs similarly have many challenges with controversies related to their categorical assignment. Due to their malignant potential, some favor these neoplasms be categorized as “malignant.” European Neuroendocrine Tumor Society (ENETS) and World Health Organization categorize low and intermediate grades of these as “tumor” or “neoplasm” in the absence of high-grade criteria (>50 mitoses per 50 high power field for NETs of pancreas and >20 mitoses per 10 high power field or Ki-67 index >20% for NETs of other sites).[18,19] Undoubtedly, the lesions with unequivocal cytological features of either small cell carcinoma or large cell undifferentiated carcinoma belong to the “malignant” category. An increasing trend with incidental NETs in surgically unfit older patients, favors a conservative approach for small NETs as an alternative management strategy. The categories proposed in the current guidelines permit practical flexibility by surgeons in order to assure that conservative strategies may be a better option than the surgery. This would be more confusing if these cases of low grade neoplasms automatically fell in a “malignant” category! Utilization of ancillary testing including molecular testing in cystic lesions is also addressed in appropriate areas.[13] With input from the guidelines by the National Cancer Center Network (www.nccn.org) and by the multidisciplinary international groups in the field of pancreatology, post cytologic evaluation and management are also covered.[14] A “triple test” approach similar to that applied for FNA of breast lesions is recommended. Patient management should be determined by correlating the clinical findings in concert with endoscopic, imaging, and cytologic findings. Effective application of such guidelines is heavily dependent on the collaborative, multidisciplinary interactions between endoscopists, pancreaticobiliary surgeons, radiologists, and cytopathologists. The current CytoJournal supplement issue with individual articles[10,11,12,13,14] covering various areas highlighted above would be a great resource under Open access platform[20,21] for all involved in the management of pancreaticobiliary lesions. These PSC guideline articles published under Open Access charter may be disseminated by multiple journals/platforms[22,23,24,25,26] including e-CytoJournal issue http://www.cytojournal.com/browse.asp?sabs=n.[27] more...
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- 2013
246. Significance of the diagnostic categories 'atypical' and 'suspicious for malignancy' in the cytologic diagnosis of solid pancreatic masses
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Lester J, Layfield, Robert L, Schmidt, Sharon L, Hirschowitz, Matthew T, Olson, Syed Z, Ali, and Leslie L, Dodd
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Pancreatic Neoplasms ,ROC Curve ,Cytodiagnosis ,Biopsy, Fine-Needle ,Humans ,Endosonography - Abstract
Endoscopic ultrasound guided (EUS) fine-needle aspiration (FNA) investigation of solid pancreatic lesions has been shown to have good sensitivity and specificity. Many lesions can be definitely classified as benign or malignant but some can only be cytologically classified as "atypical" or "suspicious for malignancy". Risk for malignancy in these indeterminate categories has not been well categorized. The cytology records of four University Medical centers were searched for all EUS guided FNAs of solid pancreatic lesions. All cases with a diagnosis of "atypical", or "suspicious for malignancy" were selected for analysis when histologic biopsy or over 18 months clinical follow-up was available. Two hundred and ninety-two cases with a diagnosis of "atypical" or "suspicious for malignancy" and adequate follow-up were obtained from the combined data of the four institutions. The percentage malignant for the categories "atypical" and "suspicious for malignancy" were 79.2 and 96.3%, respectively. If the category "atypical" was classified as benign and "suspicious for malignancy" was classified as malignant, the resulting positive predictive value was 96.3 (95% CI: 92.6-98.5) and the negative predictive value 20.8 (95% CI: 13.4-30.0). The categories of "atypical" and "suspicious for malignancy" stratify risk for malignancy in a fashion, which may aid in patient counseling and selection of follow-up protocols. Classification of "suspicious for malignancy" as malignant optimizes diagnostic sensitivity and specificity. more...
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- 2013
247. Rapid on-site evaluation reduces needle passes in endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: a risk-benefit analysis
- Author
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Robert L. Schmidt, Brandon S. Walker, Kirsten Howard, Douglas G. Adler, Lester J. Layfield, Schmidt, Robert L, Walker, Brandon S, Howard, Kirsten, Layfield, Lester J, and Adler, Douglas G
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Endoscopic ultrasound ,ROSE ,Sampling protocol ,medicine.medical_specialty ,medicine.diagnostic_test ,Physiology ,business.industry ,Gastroenterology ,Sampling (statistics) ,Bayes Theorem ,Site evaluation ,Variable sampling ,Sensitivity and Specificity ,Pancreatic Neoplasms ,Fine-needle aspiration ,Increased risk ,FNA ,Risk-benefit analysis ,medicine ,Humans ,Radiology ,pancreas ,business ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,EUS - Abstract
Background: The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized. Aims: The purpose of this study was to compare the risk-benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE). Patients and Methods: We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy Results: Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE. Conclusions: Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes. Refereed/Peer-reviewed more...
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- 2013
248. The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology: a systematic review and meta-analysis
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Robert L, Schmidt, Benjamin L, Witt, Leslie E, Lopez-Calderon, and Lester J, Layfield
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Quality Assurance, Health Care ,Biopsy, Fine-Needle ,Humans - Abstract
Rapid onsite evaluation (ROSE) has the potential to improve the adequacy rates of fine-needle aspiration (FNA) cytology. Studies have obtained variable results on the influence of ROSE. We conducted a systematic review and meta-analysis of studies on the influence of ROSE on FNA adequacy. We synthesized evidence across all anatomic locations. We only included studies that contained a control arm and compared cohorts with ROSE against cohorts without ROSE at a single location. We screened 2,179 studies and identified 25 studies that met our inclusion criteria. On average, ROSE improves the adequacy rate by 12%, but there was considerable variability across studies. The adequacy rate with ROSE depends on the non-ROSE adequacy rate. Sixty-five percent of the variability in the adequacy rate with ROSE was found to occur because of differences in the adequacy rate without ROSE. Studies with high non-ROSE adequacy rates showed low improvement after ROSE was implemented. Studies must account for the effect of the non-ROSE adequacy rate to determine the effect of ROSE on FNA adequacy rates. more...
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- 2013
249. Fine-needle aspiration of inflammatory carcinoma of the breast
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Leslie G. Dodd and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,business.industry ,Mammary gland ,Adipose tissue ,General Medicine ,medicine.disease ,Pathology and Forensic Medicine ,Lesion ,Lymphatic system ,Fine-needle aspiration ,medicine.anatomical_structure ,Cytopathology ,Carcinoma ,medicine ,medicine.symptom ,skin and connective tissue diseases ,Breast carcinoma ,business - Abstract
Inflammatory carcinoma of the breast is an uncommon clinicopathologic entity which is characterized by a distinctive clinical appearance and poor prognosis. Histopathologically, it is characterized by plugging of dermal lymphatics with tumor emboli. Because this lesion usually does not form a discrete palpable mass, it is not as amenable to diagnosis by fine-needle aspiration (FNA) as other breast lesions. In the following, we report our experience with establishing the diagnosis of inflammatory carcinoma by FNA. Three patients underwent FNA for confirmation of clinically suspected inflammatory carcinoma. All aspirations were performed by a cytopathologist and required multiple passes to obtain diagnostic material. Aspirates were paucicellular and contained fragments of fibrous or adipose tissue. Malignant cells were predominantly distributed in tight, three-dimensional clusters and were identifiable as tumor cells based on large size, nuclear irregularity, and increased nuclear to cytoplasmic ratio. Unlike aspirates from conventional breast carcinoma, individual dispersed cells and cellular discohesiveness were not prominent features. Subsequent histologic material from these patients revealed the characteristic tumor emboli plugging dermal lymphatics. We conclude that in the appropriate setting, the diagnosis of inflammatory carcinoma can be established by FNA. more...
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- 1996
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250. Squamous cells in fine-needle aspiration biopsies of salivary gland lesions: Potential pitfalls in cytologic diagnosis
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Leslie G. Dodd, Eoghan E. Mooney, and Lester J. Layfield
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Pathology ,medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,Salivary gland ,business.industry ,General Medicine ,medicine.disease ,Epithelium ,Pathology and Forensic Medicine ,Pleomorphic adenoma ,Lesion ,stomatognathic diseases ,medicine.anatomical_structure ,Fine-needle aspiration ,Mucoepidermoid carcinoma ,Cytopathology ,Cytology ,medicine ,medicine.symptom ,business - Abstract
A spectrum of neoplastic and non-neoplastic lesions of the salivary glands may contain squamous cells. These include chronic sialadenitis, lymphoepithelial cyst, pleomorphic adenoma, Warthin's tumor, mucoepidermoid carcinoma, and squamous cell carcinoma. The squamous cells may be a defining feature of the lesion, or an occasional and thus unexpected finding, with a consequent potential for misdiagnosis. Clinical management of these lesions differs significantly, and careful evaluation of the squamous elements, along with attention to other cellular and background components, facilitates accurate diagnosis. more...
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- 1996
- Full Text
- View/download PDF
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